How does anyone manage the cost of expensive medicines

[alephnull]

I'm nearing the age of retirement, but fear I won't be able to because of the cost of my cancer drugs. XTandi is 15K a month, luckily my insurance pays 100%. My Orgovyx is about 3K a month, again insurance pays 100%. Insurance is through my employer. Are there any insurances for retirees that pay that well?

[Magnus1964]

You have great insurance!!! To answer your question, I am not aware of any Part D plan that would pay close to 100 percent.

[CJ4J]

One of my husband's oncologist financial staff sat down with us to go over transitioning to Medicare. What your income will be in retirement might answer that question for you, we made just a tad to much to qualify for any assistance. In our case, she said keep your company insurance as long as you can.

[mrscruffy]

See a broker that specializes in Medicare add-ons. Mine has me on a plan that has 0 deductible and $250 deductible for my Zytiga, seems like it will work for me.

[larry_dammit]

Good question, as you get to Medicare you will want to check out the supplemental insurance. Xtandi is not covered by Medicare but your supplement will pick up a large share depending on what you purchase.

[maley2711 in reply to larry_dammit]

My understanding is that supplements only cover some or all of a treatment or drug that is covered by Medicare? If Medicare A,B, or D don't cover something, then a supplement will not either?

[larry_dammit in reply to maley2711]

Part D. It has covered my Xtandi all along, we didn’t plan on getting sick so we went with a $5k deduct and a co pay. Xtandi costs me around $800 per month

[alephnull in reply to larry_dammit]

$800/month??

And that is why I probably won't retire until I just can't work anymore bc of the cancer.

[Hidden in reply to larry_dammit]

Yikes. That would be difficult for us. Glad we have the VA!

[larry_dammit in reply to Hidden]

👍👍

[Seasid]

If you can stay in employment. Only if you want.

[Bvilkid]

Check with your oncologist team, specifically the department that handles insurance claims. They should be able to tell you what specific insurance companies Medsup's best pay for whatever you're taking.

[Hidden]

Is there any way you can choose to keep your current insurance as your supplemental to Medicare? My husband gets his scripts through the VA as before he retired our insurance was too expensive on most scripts he needed. He is also diabetic, so the costs were exorbitant. When he was put on Xtandi, because he does not get scripts through Medicare, they did refer us to a group which will help in paying for it. The doctor's office also offered assistance in finding an affordable solution. There are ways to get help.

[alephnull in reply to Hidden]

COBRA, but that will probably triple my insurance cost. BUt that's an excellent idea.

[JPnSD]

Be aware of the Medicare Advantage (MA) catch 22 (or more appropriate catch 24 in this case). If you are on a MA plan for 24 months and the try to switch to regular Medicare and Part D programs...NO ONE will sell you a Medicare Supplemental Insurance plan (usually sold under AARP banner) if you have a cancer diagnosis. The ONLY way you can restart the clock is to move out of your present healthcare service area! I have learned this the hard way.

[Grandpa4]

Assistance programs for Medicare patients are limited by law. They can not provide assistance to Medicare patients unless they can show need. The idea is that you would use medications you could not otherwise afford and Medicare considers that fraud. So if you are asked to fill out financials to prove financial need do it. There is weird part or or pharmacy system that makes no sense to me. It is often much cheaper to pay cash. In my case I am paying $250 a month form Abiraterone and not using my insurance . If I used my insurance it would be $2000 a month until my $6000 co pay has been met. Then they cover 100%. To get a cash price you can often use GoodRx or similar programs.

[Concerned-wife]

You can input your drugs on medicare.gov to help choose a part D plan. You can also study part b supplements there. Might be called medigap plans. Lots of info to study before u turn 65. Easy to change part d plans annually but not supplements. Talking to a broker may help. Just make sure you understand what products they sell. They are paid by the plan

[dhccpa]

My plan D pharma add on plan is AARP Walgreens (I'm in Florida). I'm not on Zytiga but this plan has the generic version at Walgreens for $110/month. I also get Lupron shots at MO's office, covered fully under Medicare Part B.

[j-o-h-n]

Marry a very young woman who has a terrific health insurance plan for herself and her spouse.....(and remember to keep her very happy).....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 06/28/2022 5:29 PM DST

[Echotango51]

Have have been retired for 6 years, just started taking xtandi last week. My URO works with a specially para too get xtandi. I get xtandi at no cost because I live only on SSI, I haven’t taped into my retirement funds. I have no taxable income. I don’t know what your retirement income will be but if you can show a limited income that will help. If I had to use my Medicare advantage plan it would close me $3000 a month. Bless of luck to you.